12a.) Mood Disorders Flashcards
What mood disorders do you need to be aware of at this stage?
- Depression
- Bipolar
- Type 1
- Type 2
State the 3 core symptoms of depression
- Low mood
- Lack of energy
- Lack of enjoyment & interest
How long must patients have symptoms of depression for to be classed as clinically depressed?
Symptoms continually for 2 weeks
Alongside the core symptoms of depression, state some other symptoms
Core Symptoms
- Low mood
- Lack of energy
- Lack of enjoyment & interest
Others
- Depressive thoughts: burden, guilty, poor outlook
- Somatic symptoms/biological symptoms: not eating, sleeping or drinking which can lead to weight loss and electrolyte distrubances
- In severe cases psychotic symptoms
Explain the difference between an adjustment reaction (e.g. after death of a loved one) and depression
What is the typical sleep disturbance pattern in people who are depressed?
Early morning wakening
State some features of mania
- Elated mood
- Increased energy
- Pressure of speech (talk very fast)
- Decreased need for sleep
- Flight of ideas
- Normal social inhibitions are lost
- Attention cannot be sustained
- Self esteem is inflated, often grandoise
- May have psychotic symptoms
Describe the difference between mania and hypomania
Hypomania is ‘milder’ form of mania
What is bipolar affective disorder?
Condition in which someone’s mood varies, GENERALLY, between two states: mania/hypomania and depression.
NOTE: diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania hence you don’t ever have to have a diagnosis of depression to be given bipolar disorder diagnosis
Do you have to have a diagnosis of depression to be given diagnosis of bipolar disorder?
No. Diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania. Hence, you don’t ever have to have a diagnosis of depression to be given diagnosis of bipolar disorder.
Describe the difference between bipolar type 1 and bipolar type 2
- Bipolar type 1: discrete episodes of mania only or mania and depression (need at least 2 episodes)
- Bipolar type 2: discrete episodes of hypomania only or hypomania and depression (need at least 2 episodes)
How long does bipolar episodes last?
Varies for individuals but generallyd depressive states last longer than manic states
If someone comes in with depressive symptoms, what physical health differentials might you make and want to rule out?
If someone comes in with mania symptoms what physical differentials might you make and want to rule out?
State 3 brain structures involved in mood disorders
- Limbic system
- Frontal lobe
- Basal ganglia
Describe the main hypothesis for mood disorders
State the 3 main functions of the limbic system
- Emotion
- Motivation
- Memory (hippocampus & amygdala in particular)
We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the limbic system for:
- Unipolar depression
- Bipolar affective disorder
Where is the pre-frontal area?
State some functions of the frontal lobe
- Motor function
- Language (Broca’s)
- Executive functions (purposeful goal directed behaviours e.g. when you go to shop to buy things for a meal, all the things you have to think about and do in the correct order)
- Attention
- Memory
- Mood
- Social & moral reasoning
State at least 3 functions of the pre-frontal cortex
Responsible for the so called ‘executive functions’:
- Emotional responses
- Behaviour & judgement
- Attention
- Impulse control
- Plan & organise
- Problem solving
- Decision making
The ventromedial prefrontal cortex is thought to be involved in what?
Generation of emotions
The orbital prefrontal cortex is thought to be involved in what?
Emotional responses possibly via connection with the amygdala
We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the frontal lobe in:
- Unipolar depression
- Bipolar affective disorder
Basal ganglia have motor functions and psychologica functions; state 3 psychological functions of basal ganglia
- Emotion
- Cognition
- Behaviour
We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the basal ganglia for:
- Unipolar depression
- Bipolar affective disorder
For depression, state what symptoms/features abnormalities in each of the following structures leads to:
- Prefrontal cortex
- Amygdala
- Basal ganglia
- Prefrontal cortex: slowing of thought, altered executive function & altered emotional processing
- Amygdala: abnormal emotional processing
- Basal ganglia: impaired incentive behaviour, psychomtoor changes
What are the two main neurotransmitters involved in depressive disorders?
- Serotonin
- Noradrenaline
(both are monamines)
What is the monoamine hypothesis?
Suggests that depressive disorders are due to abnormality in the availability of monoamines (e.g. serotonin & NA)
**BOTH serotonin & NA are low in depression
For serotonin, state:
- Where it is produced
- What it has roles in
- Produced in brain stem (Raphe nuclei) and transported to cortical areas & limbic system
- Role in:
- Sleep
- Impulse control (link with suicide)
- Appetite
- Mood
Describe 3 pieces of evidence to support argument that serotonin is low in patients with depression
For noradrenaline, state:
- Where it is produced
- Functions in brain
- Produced in locus coeruleus (pons) and projects to limbic system & cortex
- Functions: mood, role in behavioiur (arousal & attention), implicated in memory functions
Describe 3 pieces of evidence to suggest that NA is decreasd in depression
Describe the biopsychosocial treatment for depression
-
Biological
- First liine: SSRIs
- Others: SNRIs, TCAs
- If life-threatening/resistant depression: ECT
-
Psychological
- First line: CBT
-
Social
- Help with e.g. isolation, social stressors etc..
Describe the biopsychosocial treatment of mania
-
Biological
- First line: antipsychotics
- Alternatively: mood stabiliser
-
Psychological
- Acutely will be unhelpful but longer term eduction regarding triggers and how to notice signs of relapse is beneficial
-
Social
- Treat in place of safety, consider implications of mania e.g. excessive spending, STIs…
Describe the biopsychosocial treatment for bipolar depression
*NOTE: we have to treat it different to unipolar depression as risk of sending them manic
-
Biological
- Can use antidepressant BUT ONLY IF ALSO ON a mood stabiliser to prevent going hypomanic/manic
-
Psychological
- CBT
-
Social
- Same as for unipolar depression so help with e.g. isolation, social stressors
Describe the biopsychosocial treatment for maintaining stability in bipolar disorder
-
Biological
- Mood stabilisers
- Some antipsychotics can be used as mood stabilisers
-
Psychological
- Psychoeducation
- CBT
-
Social
- Consideration of lifestyle on bipolar e.g. shift work, stressful life…. involve family and educate family also
